Behind the Scenes | Thursday, April 14, 2022
SGNA Annual Course Preview: Fecal Transplantation — State of the Science for Gastroenterology Nurses
SGNA is gearing up for the 49th SGNA Annual Course: Reunite, Recharge, Reflect, taking place May 22-24 in Salt Lake City, Utah! The Inside Tract is speaking with presenters to get insights on what you can expect from their sessions and why you won’t want to miss this year’s event.
We interviewed Kathy A. Baker, PhD APRN ACNS-BC FCNS FAAN, and Carsyn Poole, Senior II Nursing Student, Texas Christian University (TCU), who will present “Fecal Transplantation: State of the Science for Gastroenterology Nurses.” Here, Baker and Poole share more about the many uses of fecal transplantation in medicine.
What is fecal microbiota transplantation?
Fecal microbiota transplantation (FMT) is a procedure that uses the healthy gut microbiota from a donor individual, implanting it into a recipient’s bowel to help regulate abnormal alterations in the recipient’s microbiome. The gut microbiome consists of all the organisms and their genes that live in your gut (i.e. bacteria, viruses, fungi, protozoa and even worms [helminths]) (Chutkan, 2015). FMT restores the gut’s barrier defense to disease by stimulating the mucosal immune system through the donor’s healthy microbiota (Sandhu & Chopra, 2021).
FMT was first cited as a potential treatment in 2011. The procedure was approved in the United States by the FDA in 2016 but is widely used globally. Initially, FMT was used as an intervention to manage recurrent Clostridioides difficile (C. difficile), but clinicians are now exploring FMT outcomes for other disease states.
What’s new and trending in this area of practice?
Because the initial results from FMT for treatment of C. difficile were so promising, FMT is now being explored as treatment in IBD, IBS, cancer (particularly melanoma) (Baruch et al., 2021), sepsis (Keskey et al., 2020), hepatic encephalopathy (Mehta et al., 2018), autism, Parkinson’s disease, schizophrenia, Alzheimer’s disease, multiple sclerosis, anxiety and depression, even weight loss and functional constipation (Waller, Leong, & Paramsothy, 2022).
Initially, FMT was delivered via colonoscopy using fresh donor stool from the patient or a relative. Over time, FMT has been administered through different routes (nasogastric/jejunal, gastroscopy, sigmoid/colonoscopy) and methods (capsules, retention enema) (Gulati et al, 2020). Capsules are a major breakthrough because they are efficacious, easy to administer and noninvasive, so serious adverse events are minimal (Du, Luo, Walsh, Grinspan (2021). Donor stool can now not only be administered as a fresh preparation, but also frozen or lyophilized (freeze-dried). And instead of stool having to be collected and administered quickly to the recipient at the procedural site, donor banks are being established worldwide to provide microbiota from highly screened donors (Chen, Zama, Ramakrishna, & Olesen, 2021).
What led you to research fecal microbiota transplantation?
As a gastroenterology (GI) clinical nurse specialist, I have been intrigued with learning as much as I can about the gut microbiome. Two recent publications in particular, The Mind-Gut Connection (Mayer, 2016) and The Microbiome Solution (Chutkan, 2015), were transformational for me in realizing this is an area I really needed to understand. I have observed that many GI nurses have heard of the microbiome but are not as familiar with its implications for wellness beyond the GI system.
At a recent meeting, a nursing editor colleague and I were discussing the science behind the microbiome and its foundational relationship to our immune system, as well as our psychological health. She enjoyed the conversation enough that she asked me for a manuscript on the topic for her journal. It just so happened I was beginning work with a Texas Christian University honors student who was willing to assist me in conducting a scoping review on FMT. We were overwhelmed to find how much literature has been published in the last decade, but also excited to recognize how rapidly this procedure has expanded as a potential treatment for multiple disease processes and disorders.
Can you share a recent finding in fecal transplantation?
A recent randomized control trial (Bajaj et al., 2021) found FMT to be useful, at least short term, in reducing alcohol craving and consumption in individuals with alcohol-associated cirrhosis due to alcohol misuse. Their study of 20 adult men with a Model for End-Stage Liver Disease (MOSD) score of 8.9 + 2.7 found alcohol cravings were significantly reduced in 90% of the FMT group compared to 30% in placebo.
The treatment group also reported improved cognition and psychosocial quality of life. Microbial gut diversity was also increased in the treatment group and they had fewer serious adverse events compared to the placebo group. Further studies in this population need to be done, but the findings are promising and demonstrate the critical contributions of a healthy microbiome for promoting health in the presence of disease.
What will attendees take away from the session?
Through the lens of a GI nurse, our session will focus on providing attendees a review of what we have learned about FMT over the past decade within the context of what we know about the microbiome. We will share an overview of the populations, procedures and treatment outcomes for FMT, as well as future possibilities for this life-changing treatment.
Bajaj, J. S., Gavis, E. A., Fagan, A., et al. (2021). A randomized clinical trial of fecal microbiota transplant for alcohol use disorder. Hepatology, 73(5):1688-1700. doi:10.1002/hep.31496
Baruch, E. N., Youngster, I., Ben-Betzalel, G., et al. (2021). Fecal microbiota transplant promotes response in immunotherapy-refractory melanoma patients. Science, 371(6529), 602-609. doi:10.1126/science.abb5920
Chen, J., Zaman, A., Ramakrishna, B., & Olesen, S. W. (2021). Stool banking for fecal microbiota transplantation: Methods and operations at a large stool bank. Frontiers in Cellular and Infection Microbiology, 11, 622949. doi.org/10.3389/fcimb.2021.622949
Chutkan, R. (2015). The Microbiome Solution: A Radical New Way to Health Your Body form the Inside Out. Penguin Random House.
Du, C., Luo, Y., Walsh, S., Grinspan, A. (2021). Oral fecal microbiota transplant capsules are safe and effective for recurrent clostridioides difficile infection. Journal of Clinical Gastroenterology, 55(4), 300-308. doi: 10.1097/MCG.0000000000001495
Gulati, M., Singh, S. K., Corrie, L., Kaur, I. P., & Chandwani, L. (2020). Delivery routes for faecal microbiota transplants: Available, anticipated and aspired. Pharmacological Research, 159, 104954. doi:10.1016/j.phrs.2020.104954
Keskey, R., Cone, J. T., DeFazio, J. R., & Alverdy, J. C. (2020). The use of fecal microbiota transplant in sepsis. Translational Research: The Journal of Laboratory and Clinical Medicine, 226, 12-25. doi:10.1016/j.trsl.2020.07.002
Mayer, E. (2016). The Mind-Gut Connection. Harper Wave/Harper Collins Publishers.
McQuade, J. L., Ologun, G. O., Arora, R., & Wargo, J. A. (2020). Gut microbiome modulation via fecal microbiota transplant to augment immunotherapy in patients with melanoma or other cancers. Current oncology reports. 22(7), 74. doi:10.1007/s11912-020-00913-y
Mehta, R., Kabrawala, M., Nandwani, S., Kalra, P., Patel, C., Desai, P., & Parekh, K. (2018). Preliminary experience with single fecal microbiota transplant for treatment of recurrent overt hepatic encephalopathy-A case series. Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology, 37(6), 559–562. https://doi.org/10.1007/s12664-018-0906-1
Waller, K. M. J., Leong, R. W., & Paramsothy, S., (2022). An update on fecal microbiota transplantation for the treatment of gastrointestinal diseases. Journal of Gastroenterology and Hepatology, 37, 246–255. doi:10.1111/jgh.15731